Hand hygiene is the best method to prevent the transmission of infections. Hand hygiene for hospitalized patients sounds obvious – something that should be easy to accomplish and regarded as important to the patient experience. However, patient hand hygiene is a problem for most hospitals today. It is difficult to accomplish and not monitored by healthcare personnel. No infection preventionist will argue against the importance of patient hand hygiene. However, since it is neither prioritized nor measured by hospitals, it falls through the cracks. This, coupled with the fact that more and more research points to patients as the “missing link” in infection control efforts means that, in order to reduce hospital acquired infections (HAIs), hospitals need dedicated efforts to improve patient hand hygiene. Key to achieving these efforts is empowering patients to make hand hygiene easy to do on their own and to understand the critical importance cleaning their hands plays in preventative care.

Hand hygiene is the best method to prevent the transmission of infections. Hand hygiene for hospitalized patients sounds obvious – something that should be easy to accomplish and regarded as important to the patient experience. However, patient hand hygiene is a problem for most hospitals today. It is difficult to accomplish and not monitored by healthcare personnel. No infection preventionist will argue against the importance of patient hand hygiene. However, since it is neither prioritized nor measured by hospitals, it falls through the cracks. This, coupled with the fact that more and more research points to patients as the “missing link” in infection control efforts means that, in order to reduce hospital acquired infections (HAIs), hospitals need dedicated efforts to improve patient hand hygiene. Key to achieving these efforts is empowering patients to make hand hygiene easy to do on their own and to understand the critical importance cleaning their hands plays in preventative care.

Kathleen Puri had been a nurse for many years, but it wasn’t until she became a hospital patient that the issue of hospital patient hygiene began to truly bother her. She noticed that patients confined to a hospital bed had no way to conveniently and easily wash their hands — one of the easiest ways to prevent the almost 100,000 deaths (more than those caused by diabetes or breast and prostate cancer combined) attributed to infections acquired in hospitals annually.

The AJIC study focused on educating patients on when to perform hand hygiene. Defining five specific events or “moments” in the day of the patient was found to help patients remember when to perform hand hygiene. Besides the usual before eating, after using the rest room, before and after touching drains / devices, and upon entering and leaving the room, a fifth moment was added - perform hand hygiene upon the entrance of healthcare personnel into the room.

This fifth moment proved to be powerful because it was a non-verbal reminder to healthcare personnel to wash their hands while the patient also performed hand hygiene. A win-win.

Hand sanitizer was provided to the patients along with education regarding the importance of hand hygiene in the hospital and the study findings showed these interventions improved the frequency of patient hand hygiene. Of course, it makes sense that having hand sanitizer easily accessible will improve hand hygiene, but defining the five moments to clearly identify when to clean their hands provided structure to the hospital experience.

Fitsi, our bed caddy, provides a place to have hand sanitizer easily accessible along with storage for personal items. Our mission is to help patients engage with their care while providing a way to help reduce hospital acquired infections.

The safety of products with triclosan is in question. Triclosan is in a large variety of products, many of which are used in healthcare.

When Fitsi Health was making manufacturing decisions the goal was to make Fitsi® as durable as possible. The decision was made to include an antibacterial agent into the plastic we used to make the injection molded bedside caddy. Some people recommended triclosan since it is already used in a variety of healthcare products. But, just as the FDA stated, studies found that hormones and antibiotic resistance may be influenced by triclosan.

As a result, Fitsi Health decided not to use triclosan when making Fitsi® even though it would have been our cheapest option. Instead, Fitsi is imbedded with MicroBlok S. MicroBlok S is a silver ion with a high antimicrobial efficiency that protects Fitsi from staining and deterioration.

Making a product has many dimensions and decisions. Fitsi Health is happy to have made the decision to use MicroBlok S and not use triclosan. Safety is always first!

Fitsi bedside caddy promotes patient hygiene

Device integrates antimicrobial technology from Plastics Color Corp.

By Norbert Sparrow

April 29, 2016

A bedside caddy developed by a nurse could help combat hospital-acquired infections (HAIs) simply by making it more convenient for patients to wash their hands. Plastics Color Corp. (PCC; Calumet City, IL), a supplier of custom polymer solutions, compounds, colorants and additive masterbatches with a global footprint, brought its expertise to the project and shared this story.

We are often told that washing our hands is the first line of defense against spreading germs and contracting a cold or the flu. You would think that diligent hand washing would be second nature in a hospital setting, but the facts tell us otherwise. Public health organizations estimate that 1.7 million HAIs occur in U.S. hospitals each year, resulting in 99,000 deaths and an estimated $20 billion in healthcare costs. While basic hygiene is only one of many contributing factors to HAIs, it is a simple and remarkably effective tool. While medical personnel, we assume, follow protocol, several studies indicate that patients do not, as a rule, wash their hands as often as they should. It’s not always their fault. Many patients are bedridden, for example, and it may be painful, even impossible, for them to get to the sink. That is what prompted nurse Kathleen Puri to invent the Fitsi bedside caddy.

The Fitsi bedside caddy allows patients to keep hand sanitizer, lip balm, lotion and other basic care essentials within arm’s reach. It serves as a physical reminder to practice hand hygiene. Designed with a flat bottom and a rotatable clip, Fitsi can sit on a bedside table or conveniently attach to a patient’s bedside rail. A built-in handle allows patients to pick up the caddy and take it to the bathroom.

The Fitsi’s good influence extends beyond the patient. In its press release, PCC notes that hospital visitors are derelict when it comes to washing their hands, and, citing a New York Timesarticle, that even “hospital workers wash their hands as little as 30% of the time that they interact with patients." In this context, the Fitsi serves as a physical reminder that will help patients, their caregivers and their visitors to practice good hand hygiene, notes PCC.

Considering that the device is designed to help patients avoid infections, it’s only fitting that the Fitsi have built-in antimicrobial features, says PCC. Puri and her team settled on MicroBlok S, an antimicrobial formulation developed by PCC.

MicroBlok S inhibits the growth of a broad spectrum of microorganisms on surfaces, reduces stains and odors, and impedes deterioration thanks to the uniform dispersion of silver ions throughout a polymer matrix. The silver ions create a large internal-specific surface within the polymer, producing high-efficiency antimicrobial action, according to the company. The antimicrobial effect is not diminished over time, and the MicroBlok product line can be custom blended in a variety of resins, including TPU, PC, ABS, PP, and PE.

Listen here to Chattanooga Business Radio's interview with Fitsi Co-Founder Kathleen Puri. Kathy was given the opportunity to share the story of Fitsi Health and how the company is helping to achieve the goal of zero preventable hospital deaths by 2020. Kathy talks about how Fitsi is much more then a bedside caddy - it is part of the Patient Safety Movement and how important it is to advocate to improve patient safety.

Mayo Clinic Center for Innovation: We recently asked Fitsi Health co-founder Caroline Mitchell how her organization defines Human-Centered Design, and how this affects their process and work. Here she talks about four key questions that helped shape her team’s Human-Centered Design process.

Q 1: What do we already know? Start with really understanding the patient experience and identifying the greatest areas for improvement.

The design process for Fitsi Health starts with our founder, Kathleen Puri, MSN, RN. For years, working as a nurse and educator, Kathy was bothered by the fact that there was no way for patients to clean their hands on their own when confined to a hospital bed. Each year, more people die of hospital acquired infections than diabetes or breast and prostate cancer combined. And clean hands are the best way to prevent these infections. The fact that there was no easy way to keep patient hands clean seemed like a huge risk no one was addressing.

This frustration grew when she became a patient and saw things from the other side. Lying in a hospital bed she felt helpless – unable to reach her phone, glasses, and with no way to clean her hands.

She concluded that patients are simply too dependent on healthcare workers for help with these simple but critical tasks. Something needed to change. On the flip side, as a nurse, she knew all too well how incredibly busy everyone working in hospitals is. Creating more work for hospital staff wasn’t the solution. She wanted to find a way to improve the patient experience by empowering patients.

Fitsi co-founder Kathleen Puri working with nurses in an innovation session.

Q2: How do we dig deeper? A human centered approach means going beyond what is being measured or tracked today.

So we had this problem that was deeply rooted in the nurse and patient experience…How did we use Human-Centered Design to develop a solution?

We realized this was because the average hospital has no way to measure patient hand hygiene or, for that matter, many of the other basic elements that constitute what we call the patient experience.

So, how do you develop a product in a market where there is no baseline?

Our team started by talking to numerous nurses and hospital staff. When asked the question: “How many times did your patients clean their hands during your shift?” the answer was generally along the lines of “I’m not sure but I know it was not enough”. Healthcare workers frequently seemed stunned by the realization that they rarely thought of patients performing hand hygiene.

Q3: How do we create a more human experience than what exists today? Human-centered design is about creating something that opens up others’ eyes to new possibilities.

This led to other conversations about what, Kathleen, our founder, also knew to be problematic with today’s patient experience. Instead of focusing solely on gathering data to support the need for patient hand hygiene, we focused on the overall experience and took testing a step further…exploring more than what we originally set out to understand.To do this, we really tried to tap into the creative side of the nurses we worked with in our testing labs. We asked them to play their most difficult patient. By giving them the ability to play, the nurses went beyond “testing” and started role-playing various scenarios where they could see patients using the product.

They sought out possibilities we hadn’t even thought of: Things like having easy access to moisturizer to help with dry hands or lip balm for chapped lips (both common side effects of many medications). And what we thought was mostly a convenience or mobility issue for patients with accessing mobile phones and glasses was also a huge issue for nurses. We learned nurses spend up to ten minutes per shift searching for phones, glasses, and even dentures that get lost or misplaced in the bed.

What’s even worse is that these items are often not found or end up getting damaged. It creates unnecessary stress for patients and staff. Not to mention the cost of replacing these items. A pair of dentures can run as high as $4,500. Had we only focused on patient hand hygiene, certain features of Fitsi – like the storage areas – would have not taken shape so easily.

Q4: How can we make a bigger impact (and not just a product)? Human-centered design is messy. It's about improving real life experiences.

On the most fundamental level, human-centered design for the Fitsi team means creating products that engage patients. Human-centered design also embraces that fact that people are different. And so we designed Fitsi knowing that every patient experience is different. With Fitsi, patients and hospitals can customize the contents to best cater to their specific needs.

By focusing on the experience of patients and nurses we were able to create a product that addresses a real need and helps educate the healthcare community about the importance of patient hand hygiene.

If patient hand hygiene was something that hospitals regularly measured I think a solution like Fitsi would have been developed years ago. It took understanding the experience of patients from the eyes of a nurse to know that the problem was real.

Nurses are pulled in so many different directions which impacts the time spent being with their patients. In my personal experience, patients that perceive nurses as too busy to talk to them are more anxious and uncertain about their care.

The idea for Fitsi is simply to give patients more. They not only made it easy for patients to clean their hands but also gave them a place to store their phones, glasses and access to comfort items like lip balm and moisturizer. It is a product designed to help patients feel more independent but also save nurses time.

The opportunities for improving the patient experience are vast. Just ask any doctor or nurse and he/she will tell you several improvements that could be made. This experience has taught the team at Fitsi that some of the best ideas for new healthcare products come from empowering those on the frontlines. It is a lot of work but belief that better design means better care, and makes everyone excited to be making a real impact in patients lives. The opportunities are endless, and listen to the whole conversation after the break!